History of the Paul Coverdell National Acute Stroke Registry

More than 700,000 Americans suffer from a stroke each year; about 25% of them die, and 15–30% remain permanently disabled. More than a million Americans and their families live with the disabling effects of stroke. The direct and indirect costs of stroke care exceed $51 billion annually. To help reduce the nation's stroke burden, in addition to efforts to prevent strokes, we need to improve the quality of care provided to patients with acute stroke and thus reduce death and disability from these events.

However, a major problem is that while evidence-based medical guidelines for stroke care have been developed, with new and improved diagnostic and treatment tools, many hospitals still do not have the organization, staff, and equipment to effectively diagnose and treat acute stroke patients.

In response to this urgent public health need, Congress provided funding in 2001 to CDC to implement state-based registries that measure, track, and improve the delivery and quality of stroke care. Congress further directed that this project be named the Paul Coverdell National Acute Stroke Registry, after the late U.S. Senator Paul Coverdell of Georgia, who suffered a fatal stroke in 2000 while serving in Congress.

Coverdell Registry Prototypes
CDC began by consulting with stroke experts and organizations to develop specific categories for collecting data and then piloted eight prototype registry projects, led by academic and medical institutions across the country, to test models for measuring delivery of care. "Wave I" projects were funded in 2001, located in Georgia, Massachusetts, Michigan, and Ohio. "Wave II" projects were funded in 2002 and located in California, Illinois, North Carolina, and Oregon. Under these prototypes, data were gathered along each step of the entire process of stroke care, from emergency response to eventual discharge from a hospital. At the end of the 3–year demonstration period, the results documented large gaps between the recommended treatment guidelines and actual hospital practices. Intensive quality improvement efforts were needed to close those gaps.

Based on results from these prototypes, in June 2004, CDC funded four state health departments to establish statewide Paul Coverdell National Acute Stroke Registries with the mission of monitoring and improving the quality of acute stroke care in samples of acute care hospitals in their states. Those four states were: Georgia, Illinois, Massachusetts, and North Carolina.

In their first year, these state registries created advisory councils to provide expert guidance, recruited and trained hospitals to participate in the registry, and began collecting data on acute stroke care. The data that these states collected are now being analyzed to guide quality improvement interventions at the hospital level that will help close the gap between guidelines and practice through partnership with hospital doctors and administrators.

The PCNASR Today
In 2007, CDC announced a new opportunity for funding state health departments to implement the Paul Coverdell National Acute Stroke Registry. In July 2007, CDC announced that six states were awarded grants to establish these stroke registry programs. These states are:

• Georgia

• Massachusetts

• Michigan

• Minnesota

• North Carolina

• Ohio